Acute Haemorrhagic Leuco-encephalitis

Abstract

Itwas in1940thatWestonHurst(1941) encounteredtwo cases offatalencephalitis whichhe regarded on clinical andpathological grounds as representing a previously unidentified entity to whichhe gave thename ofacutehaemorrhagic leuco-encephalitis. To quoteHurst'soriginal description, thedisease was an acute'cerebral condition, virtually localized asfarasthecerebrum was concerned tothewhite matter, anddeveloping more or lessabruptly in apparently normal individuals. Perivascular necroses,perivascular andfocaldemyelination, haemorrhages, oedema, andcellular infiltration were thechiefcomponents ofthepathological picture. Inthe12yearssinceHurst's paperappeared remarkably fewsimilar caseshavebeenreported, andinfactonlyfivefurther examples havebeen described underthesame name. Thesehavebeen recorded byHensonandRussell (1942), Shallard andLatham(1945), MacArdle, van Bogaert, and Lhermitte (1949, two cases) andby Greenfield (1950). Itso happensthatthreecharacteristic examples ofthedisease haveoccurred inthe neurosurgical department ofSt.George's Hospital over a two-year period, anditseems probable that thecondition isnotsuchan extremerarity asthe smallnumberofrecorded caseswouldindicate. Theobject ofthepresent communication istoput on record thesethreefurther cases(bringing the numberrecorded up to10)andtodrawtheattentionofgeneral pathologists totheexistence ofthis variety ofencephalitis. Thedescriptions ofthe disease whichfollow arebased on thethree new casestogether withthesevenpreviously reported. Moredetailed summaries ofthethree cases are included inan appendix tothis paper. Clinical Features